Healthcare Provider Details

I. General information

NPI: 1063587228
Provider Name (Legal Business Name): ARTHUR BONHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 OLD SAN FRANCISCO RD
SUNNYVALE CA
94086-6385
US

IV. Provider business mailing address

301 OLD SAN FRANCISCO RD MEDICAL STAFF OFFICE
SUNNYVALE CA
94086-6386
US

V. Phone/Fax

Practice location:
  • Phone: 408-739-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: